Echocardiographic Screening of the General Population (Tromsø Study) - Echocardiographic Screening of the General Population

Description:

The goal of the trial was to evaluate echocardiographic screening compared with usual care within the general population.

Hypothesis:

Echocardiographic screening of asymptomatic individuals will allow for early disease-modifying treatment and beneficially impact long-term survival.

Study Design

  • Randomized
  • Parallel

Patient Populations:

Number of enrollees: 6,861
Duration of follow-up: 15 years
Mean patient age: 60 years
Percentage female: 57%

Primary Endpoints:

  • All-cause mortality

Secondary Endpoints:

  • Sudden death
  • Cardiovascular death
  • Myocardial infarction
  • Stroke

Drug/Procedures Used:

Asymptomatic Norwegians within the general population were randomized to echocardiographic screening (n = 3,272) versus usual care (n = 3,589).

Principal Findings:

Overall 6,861 participants were randomized. The mean age was 60 years, 57% were women, 59% had hypertension, 32% were current smokers, 12% had prior coronary heart disease, mean systolic blood pressure was 145 mm Hg, and mean cholesterol was 263 mg/dl.

In the echocardiographic screening group, valvular disease (mostly mitral regurgitation) was detected in 3.3%, ventricular hypertrophy in 1.0%, ventricular dysfunction in 1.0%, and dilated aortic root in 0.6%.

At a mean follow-up of 15 years, the primary outcome of all-cause mortality occurred in 26.9% of the echocardiographic screening group versus 27.6% of the usual care group (p = 0.48). This finding was similar among tested subgroups (i.e., 10-year risk of cardiovascular disease) when adjusted for multiple comparisons.

- Cardiovascular death: 7.6% versus 8.3% (p = 0.48), respectively, for echo versus usual care
- Sudden death: 0.5% versus 0.5% (p = 0.93), respectively
- Myocardial infarction: 12.8% versus 13.5% (p = 0.32), respectively
- Stroke: 9.8% versus 9.6% (p = 0.92), respectively

Interpretation:

Among asymptomatic individuals, echocardiographic screening did not reduce all-cause or cardiovascular mortality. As expected, the overall prevalence of structural heart disease was low, which likely limited the utility of this screening program. This study supports current guidelines, and should temper use of echocardiography for risk stratification among asymptomatic individuals.

References:

Lindekleiv H, Løchen ML, Mathiesen EB, Njølstad I, Wilsgaard T, Schirmer H. Echocardiographic Screening of the General Population and Long-Term Survival: A Randomized Clinical Study. JAMA Intern Med 2013;Jul 22:[Epub ahead of print].

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Valvular Heart Disease, Lipid Metabolism, Nonstatins, Acute Heart Failure, Echocardiography/Ultrasound, Hypertension, Mitral Regurgitation

Keywords: Cholesterol, Myocardial Infarction, Stroke, Mitral Valve Insufficiency, Heart Failure, Death, Sudden, Coronary Disease, Blood Pressure, Hypertrophy, Ventricular Dysfunction, Left, Hypertension, Echocardiography


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